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Long Term Care: Next Healthcare Crisis?

Posted by Thomas Edwards on October 10, 2019 12:50 PM EDT
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The growing baby boomer demographic group, its poor preparation for retirement and the continuing decline in overall population health.....

....combine to make the long term care "dilemma" look more and more like another healthcare crisis that could compete with resources being aimed at improving general population health related to chronic illnesses, and substance use disorder recovery.  The evidence is profoundly disturbing.  And a recent article in The Washington Post Weekly makes a compelling point that nowhere is better to assess the overall socio-economic impact than the state of Maine.

The title of the article which was published on Sunday, August 18th is "A 'Catastrophic Trend in Maine".  It is at least a wake-up call as to what is trending and ahead for the entire country.  The article also offers a compelling perspective on the enormous impact this can bring to all families in the United States.

In this blog post, I will borrow heavily by quoting key elements of the article.  And I'll conclude with several key questions that I hope my fellow bloggers on this site can respond to with subsequent entries of their own.  In the end, the purpose of this blog post is to engage thinking around organic, innovative and reasonable solutions now before the crisis becomes almost insurmountable.

In Maine, we have a model of how a third economic factor-the relative low growth rate of younger workers interested in, trained and passionate to build careers in elder care services- exacerbates the other huge socio-economic trends of declining health, aging population and lack of general population preparation for retirement.  The author, Jeff Stein in Dover-Foxcroft Maine makes some key points, which I'll note in quotation marks.

"Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces-the growth of the retirement population and a simultaneous decline in young workers-that have been exacerbated by a national worker shortage pushing up the cost of labor.  The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent".

"The disconnect between Maine's aging population and it need for young workers to care for that population is expected to be mirrored in states through the country over the coming decade, demographic experts say.  That's especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show".  The author quotes an expert on the alarming impact of this inevitable new healthcare issue emerging. "As the oldest state, Maine is the tip of the spear-but it foreshadows what is to come for the entire country," said Ai-jen Poo, coordinator of Caring Across Generations, which advocates for long-term care. 

Writer Stein's statistics are alarming.  "Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling".  Stein continues, "From 2015 to 2050, the number of Americans 85 and older will increase by more than 200 percent, while those ages 75 to 84 will rise by more than 100 percent, according to AARP.  By contrast, the number of Americans younger than 65 will increase by about 12 percent".

And author Stein makes the additional points that traditional solutions brought through government programs are not likely to resolve this issue, either in the short term or the longer term only two decades way.  Writes Stein, "With a few minor exceptions, Medicare does not pay for long-term-care services.  Medicaid offers limited benefits but is available only to the very poor.  The private market also has not been able to fill the void, as 7 percent of costs in the long-term-care market are covered by private long-term insurers".

Stein writes further, saying, "The United States is projected to have 7.8 million job openings for care workers by the middle of the next decade, making it among the fastest-growing professions in the country, with millions more finding new professions, according to the Paraprofessional Healthcare Institute, an advocacy organization.  The total cost of caring for America's elderly will double from $2.8 trillion to $5.6 trillion by 2047, a report by the consulting firm PwC found". 

What an enormous market to serve...or ignore...or flee as it were.!

Finally, a statement about what is being done to deal with this pending and inevitable moral, economic and social catastrophe.  Again, author Stein writes, "Congress created a commission to study the long-term-care problem.  In 2013, it issued dozens of recommendations, including a "national strategy" to help family caregivers, but a "fair number of these things have not been implemented.  Those that have been implemented are being implemented far too slowly," said Bruce Chernof, co-author of the commission's report and presient and CEO of the SCAN Foundation, which advocates on long-term-care issues".

Here are some questions that jump to mind for me when thinking about the enormity of the crisis, its almost certain escalation, and the socio-economic impact if not resolved:

-Are there lessons from the studies of disruptive innovation that can be applied to this dilemma?  How about successful solutions and lessons from the substance use disorder recovery treatment services world?

-Among advocacy groups such as AARP, what seems to be working now with the 93% of the existing long-term-care market that don't have long-term-care insurance coverage?

-What are the most promising action items in the commission report that has been largely ignored?

-How does the impact of government policy on elderly employment serve as possible sources of support and care?  And how about tax policy to family and friends providers?

-What lessons can be learned and applied from the industries that are applying openness, peering and sharing techniques such as ride-sharing, hospitality and transportation?

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